Call for acute patients to get OOH 'navigation hubs'

Tags: Boundaries

29 Oct 2007

Navigation hubs accessed via a single telephone number distinct from 999 should be set up to improve care of patients with acute medical illness, according to a new report from the Royal College of Physicians.

In its report, Acute medical care: The right person, in the right setting, first time , the RCP describes current arrangements for out of hours care outside hospital as largely inadequate and inflexible. It says patients end up going to hospital because there is nowhere else offers the reassurance and care they need.

The report, drawn up by the RCP’s Acute Medical Taskforce, claims that a wider range of acute services outside hospital is needed, with access controlled from a single point.

It says the creation of local navigation hubs would help to ensure that ill people are directed as soon as possible to the most appropriate clinical decision maker, who can diagnose their condition accurately and start treatment.

The taskforce says it wishes to replace the current approach it characterises as ‘see and greet’ with ‘see and treat’ services.

Although 999 calls would still be used for emergencies, the report says the navigation hub would be a preferred point of contact for all other acute medical care to ensure that the patient is directed to the right place. This would range from self-care advice, through to referral of the more acutely unwell patient.

A significant objective would be to direct patients away from an unnecessary acute hospital admission, in favour of attendance at an urgent care centre, an early outpatient or

GP follow up, or a dedicated specialist outreach service where these options are available, appropriate and safe.

The taskforce, which includes more than 40 representatives involved in clinical care for acutely ill people, suggests that the creation of a single well-publicised telephone number, distinct from 999, could be integrated with a “more locally relevant” NHS Direct.

It says there is also a need for more extensive public information about the role, remit, and boundaries of the various services within the emergency care network.

The report also calls for acute care to be made a priority in the introduction of electronic patient records, arguing this will help standardise the ongoing documentation by multiple practitioners and carers and also improve hand-over and transfer of care documentation.

The taskforce recommends that clinical assessment, clinical documentation and clinical management of common acute medical conditions should be standardised nationally, to reflect best practice. It says this would improve clinical practice, support clinical governance, and facilitate case review, transferability of clinical information and clinical audit. The report also recommends the introduction of a national NHS Early Warning score (NEW score) to aide assessment of illness severity and prompt an appropriate level and speed of response.

In addition, the RCP report says accurate clinical coding information should be recorded by a competent clinician on the clerking forms and recommends that the provision of reliable, high quality, IT support is prioritised in acute clinical areas to support efficient working of the emergency care network.

Professor Bryan Williams, chair of the taskforce and Professor of Medicine at the University of Leicester, said: “Getting it right for acute medical care needs changes in the way care is organised to get the most and the best out of staff and local resources and to provide fast and efficient care for patients. It needs changes in the way we work as professionals across the board, to provide wider and more flexible access to clinical decision makers. This report provides the template for a world class acute medicine service - but change itself requires more empowered clinical leadership from within the service."

Links

RCP

Reader's Comments

Yet OOH cover being reduced in real life

31 Oct 07 08:10

Another fantasy objective. in Real Life -OOH cover is being cur back, eg Bucks, Herts & Hamps have had there areas extended and the OOH nurses halved (one nurse tonight is covering 150 square miles).

The GPs have signed over to a commercial company that has NO access to the patient records or any links with the National care record. These doctors are brought in from abroad on lavish short-term contracts to fill the shortage, eg £1200 to cover the weekend, acomm and flights from Germany included.

Does it take a genius or just someone with common sense to see that the 'care in the community' concept has become 'Care BY the community' or is it just everyone else?

How long beore the government suddenly have a 'great idea' and promise to reverse this mess? Same old promises... I remember maggie thatcher promising the same thing 20 years ago, yawn!

Not the GPs

31 Oct 07 10:10

The GPs cannot hand anything over to private OOH companies. It is the PCOs that are responsible for commissioning OOH care and some have chosen to go for the cheapest option rather than the best for their patients. (some are spending as little as £2.50 per patient per year on OOH)

It is currently fashionable to knock GPs but the real scandal is why PCOs have managed, in the space of only 3 years, to destroy an OOH system that GPs set up and managed successfully for decades.

money

31 Oct 07 14:10

Hang on, GPs got more money from their new contracts at the same time as relenquishing their OOH duties.

The PCTs had to set up the new out of hours services from existing resources whilst meeting obligations under the new GP contract.

Not too suprising then that they have had to do it as cheaply as possible, or given the barriers to sharing patients records that these staff have been working with inadequate information.

money

31 Oct 07 19:10

Actually the GPs lost £6000 income (on average) when OOH was taken away. This was passed to the PCOs plus additional amounts so the funding for PCT-run OOH was higher than the government was willing to pay GPs to provide the same service.

The fact that practices did more work (or hit more targets than anticipated) and hence earned more money than anticipated for daytime work was not affected by their decision whether to keep OOH. If the GPs had kept night work they would have been earning £6000 more. As the additional PCO funding was less than this, the PCOs would have been financially worse off even if they were allowed to vire this money into other activity.